METHOD AND SYSTEM FOR INSURANCE COMPANIES CONTRACTING WITH AND PAYING MEDICAL IMAGE READING PROFESSIONALS IN A NETWORK

• US 20090204445A1
• Filed: 02/04/2009
• Published: 08/13/2009
• Est. Priority Date: 02/08/2008
• Status: Active Grant

• Current Assignee: Premerus LLC
• Original Assignee: Premerus LLC
• Inventors: Thorne, Curtis J., Allen, Gregg Phillip
• Granted Patent: US 8,224,675 B2
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/06398 Performance of employee with respect to a job function
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

A system and method for insurance companies contracting with and paying medical image reading professionals in a medical image reading professionals network. The network may be independent of a medical facility and be arranged to have each of the medical image reading professionals may be an expert in reading medical images of particular anatomical regions. The insurance companies may have lower overall costs by contracting with the medical image reading professionals who are experts in reading medical images of anatomical regions, modalities, and medical conditions as misdiagnoses are reduced due to proficiency of the medical image reading professionals.

Claims

1. A method for an insurance company to contract with medical image reading professionals, said method comprising:

receiving, by an insurance company, an application from a medical image reading professional who, to perform medical duties, receives medical information from a medical professional network manager and who has qualified to participate in a network of medical image reading professionals that the medical professional network manager manages;

verifying that the medical image reading professional is a member of the network of medical image reading professionals;

approving the application of the medical image reading professional in response to positively verifying that the medical image reading professional is a member of the network; and

establishing the medical image reading professional as a payee in performing medical services.

2. The method according to claim 1, wherein receiving the application includes receiving the application from a medical image reading professional.

3. The method according to claim 1, wherein receiving the application includes receiving an area of expertise in which the medical image reading professional practices.

4. The method according to claim 1, wherein the medical professional network manager is independent of medical care facilities.

5. The method according to claim 1, further comprising:

evaluating the medical professional network manager; and

approving the medical professional network manager as an authorized service provider such that medical image reading professionals associated with the medical professional network manager are able to submit applications.

6. A system for paying medical image reading professionals, said system comprising:

a first module configured to recognize a network of medical image reading professionals who interpret medical information of patients to qualify for medical insurance payment reimbursement, each medical image reading professional in the network having at least one rating parameter associated therewith indicative of outcome of patients who were treated based on assessments of medical conditions by a respective medical image reading professional; and

a second module in communication with said first module, and configured process insurance payment requests for the medical image reading professionals.

7. The system according to claim 6, further comprising a third module configured to pay the medical image reading professionals in the network.

8. The system according to claim 6, further comprising:

a third module configured to process an application of a medical image reading professional; and

a fourth module configured to establish the medical image reading professional as a payee.

9. The system according to claim 6, where said first and second modules are executed on a first server configured to communicate with a second server that maintains records of medical image reading professionals in the network of medical image reading professionals.

10. A method for paying medical image reading professionals, said method comprising:

recognizing a network of medical image reading professionals who interpret medical information of patients to qualify for medical insurance payment reimbursement, each medical image reading professional in the network having at least one rating parameter associated therewith indicative of outcome of patients who were treated based on assessments of medical conditions by the respective medical image reading professional; and

paying medical professionals in the network of medical image reading professionals.

11. The method according to claim 10, further comprising paying referring medical professionals who refer the patients to a medical image reading professional in the network of medical image reading professionals.

12. The method according to claim 11, wherein paying the referring medical professionals includes paying the referring medical professionals different from referring medical professionals who refer the patients to a medical image reading professional not in the network of medical image reading professionals.

13. The method according to claim 10, wherein recognizing a network of medical image reading professionals includes recognizing a network of medical image reading professionals.

14. A method of paying medical image reading professionals for performing services, said method comprising:

receiving a medical insurance claim for medical services having been performed on a patient with a medical condition of an anatomical region, the medical insurance claim indicating medical image reading services having been rendered by a medical image reading professional;

receiving an identification of a medical image reading professional who performed the medical image reading services;

confirming that the medical image reading professional is an expert in reading medical images of the anatomical region of which the patient has a medical condition; and

paying the medical image reading professional for performing the medical image reading services.

15. The method according to claim 14, wherein the medical image reading professional is in a network of medical image reading professionals that is independent of a medical facility.

16. The method according to claim 15, further comprising:

receiving a medical claim for medical service from a treating physician, the treating physician having referred the patient to a medical image reading professional outside the network; and

paying the treating physician a different amount than had the treating physician referred the patient to the medical image reading professional in the network of medical image reading professionals.